Provider Demographics
NPI:1154562080
Name:BARDWELL, ROY JAMES JR (DO)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:JAMES
Last Name:BARDWELL
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:16650 HARLEM AVENUE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-7241
Mailing Address - Country:US
Mailing Address - Phone:708-802-9355
Mailing Address - Fax:708-904-4504
Practice Address - Street 1:16650 HARLEM AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1847
Practice Address - Country:US
Practice Address - Phone:708-802-9355
Practice Address - Fax:708-904-4504
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2016-06-29
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Provider Licenses
StateLicense IDTaxonomies
IL036124712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine